Changing concepts in the diagnosis and management of thyroid nodules

Thyroid nodules are extremely common, affecting from 4% to 7% of the population. Fine-needle aspiration biopsy is the most accurate and cost-effective technique for nodule diagnosis. It is simple, safe, and should be the first test used in patient work-up. Routine thyroxine (T-4) suppressive therapy is no longer recommended for cytologically benign nodules. T-4 suppression can cause or aggravate osteoporosis, especially in postmenopausal women. New data on T-4 suppressive therapy, cost analysis, and nodule guidelines are reviewed.